Clinical predictors of inflammatory bowel disease in a genetically well-defined Caucasian population

<p>Abstract</p> <p>Background</p> <p>Crohn's disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), are multifactorial conditions of unknown etiology. The objective of this study is to examine the combined gene-environment interactions influencing IBD susceptibility in a well-defined Caucasian cohort in rural mid-America.</p> <p>Methods</p> <p>Patients were diagnosed to have CD or UC using conventional radiologic, endoscopic, and/or histopathologic findings. Histological diagnosis was made by a single specialist gastrointestinal pathologist with a particular interest in IBD. Information regarding cigarette smoke exposure was obtained by administration of the Behavioral Risk Factor Surveillance System Survey (BRFSS) to all patients. Genomic DNA was extracted from peripheral blood leukocytes, and polymerase chain reaction (PCR) amplification and genotyping were performed for 11 Single Nucleotide Polymorphisms (SNP) in <it>NOD2</it>, <it>IL23r</it>, <it>OCTN1 </it>genes along with <it>IGR</it>.</p> <p>Results</p> <p>Our cohort consists of 1196 patients: 435 controls, 485 CD patients, and 276 UC patients. Only patients with genotype data for at least 7 of 11 SNPs were included in our data analysis. The control groups for all 11 SNPs were in Hardy-Weinberg Equilibrium. In genotype-association SNP analysis, all <it>NOD2 </it>SNPs (rs5743293, rs2066844, rs2066845) and the <it>IL23r </it>SNP (rs11465804) showed a significant association to IBD (<it>p </it>< 0.03). A multiple gene-interaction analysis showed an association between <it>NOD2 </it>and <it>IL23r </it>with UC (<it>p </it>= 0.04). There were no associations between any <it>OCTN1 </it>and <it>IGR </it>SNPs and IBD in this cohort. A multivariable logistic regression analysis showed that female gender, "current" or "former" smoking status, family history of IBD, and <it>NOD2 </it>SNP minor alleles were associated with CD.</p> <p>Conclusion</p> <p>IBD remains to be challenging to properly diagnose, characterize, and treat. Our study proposes a combined genetic, phenotypic, and environmental approach in an attempt to better understand IBD. Previously demonstrated associations between OCTN1 and IGR and IBD were not confirmed.</p

Level of Comfort in Evaluating Older Patients Amongst Medical Students and Emergency Medicine Residents

Introduction As the population ages, emergency physicians must be better equipped to manage the complex needs of older patients. While geriatric core competencies have been developed for medical students and emergency medicine (EM) residents, little work has been done to evaluate EM trainees’ comfort with these competencies, or their interest in and barriers to learning more about Geriatric Emergency Medicine (GEM). Methods We conducted a cross-sectional study of EM residents and medical students in their clinical years of training with interest in EM. We used an online self-administered survey to evaluate trainees’ self-reported comfort with previously reported geriatric competency domains, in addition to exploring GEM education and interest. Results 169 trainees participated in the survey, 71% of which were medical students and 29% of which were residents. A majority of medical students (66%) and residents (92%) overall reported comfort evaluating and managing older patients in the ED, but comfort varied with each competency domain. Year of training within these groups was not reliably predictive of increased comfort across the various domains. Common barriers to learning more about GEM identified include exposure in medical education and training for medical students and residents, at 59% and 65% respectively. Medical students also noted that more exposure in preclinical and clinical training would increase interest in GEM, at 57% and 54%, respectively. For residents, learning more about what a career in GEM looks like would increase interest in GEM (51%). Common resources used to learn about older patients were society guidelines for medical students (56%) and UpToDate for residents (82%). Only 30% of medical students noted that their medical school offers a dedicated geriatric curriculum, and medical students whose medical school offered a geriatrics curriculum reported more comfort in evaluating and managing older patients in the ED. Conclusion While the majority of trainees surveyed felt comfortable in the geriatric core competencies, increased geriatrics exposure in preclinical and clinical training could increase interest in GEM. Such exposure may be best accomplished earlier in medical training and will be important in creating a future EM physician workforce that is competent in caring for this complex and important patient population